Leadership and Management - Exam #4

learning organization

an "organization where people continually expand their capacity to create the results they truly desire, where new and expansive patterns of thinking are nurtured, where collective aspiration is set free, and where people are continually learning how to learn together"

Third-Party Violence

refers to violence that is witnessed directly or indirectly by others. This often occurs when another witnesses nurse-to-nurse violence. The person who observes the violence, the third party, can experience the same harm as the victim of the violence.

position description

reflects current practice standards and provides clear, written expectations about the roles and responsibil- ities of the position

Bullying

repeated, unwanted actions intended to humiliate, offend, and cause distress in recipients

unplanned change

occurs when the need for change is sudden and necessary to manage a crisis

Nurse fatigue

the impaired function resulting from physical labor or mental exertion

innovation

the process of creating something new after thoughtful analysis of a phenomenon or situation

Standardization

the process of developing, agreeing on, and implementing uniform criteria, methods, processes, designs, or practices that can improve patient safety and quality of care

Specialty certification

validates specific knowledge, skills, and attitudes demonstrated by a nurse in a specialized area of practice

In order to facilitate a healthy working environment for nurses, which option would not be included? 1. Opportunities for education 2. Focus on limiting communication 3. Opportunities to outreach to local communities 4. Self-identification of personal challenges

2. Focus on limiting communication Focus on limiting communication would lead to an unhealthy working environment as it limits the ability to call to care. Calling to care is a part of the ANA healthy constructs to foster a conducive work environment.

A nurse has submitted a self-appraisal to the nurse manager. Upon reviewing the self-appraisal, the nurse manager decides to have a further conversation with the nurse employee if the manager observes which of the following? 1. Accomplishments for the past year 2. No mention of identified weaknesses 3. Feedback from colleagues 4. Revision of goals based on personal assessment

2. No mention of identified weaknesses Self-appraisals should contain self-reflection and identification of strengths as well as weaknesses.

corrective action

a progressive process used to improve poor performance

resume

a record of a nurse's education, employment history, accomplishmens, and achievements

self-appraisal

s the process of the employee reflecting on his or her own personal actions and professional performance related to sense of self, values, beliefs, decisions, actions, and outcomes

Self-care

"choosing behaviors that balance the effects of emotional and physical stressors. These behaviors can include exercising, eating nutritious foods, getting enough sleep, practicing self-centering activities, abstaining from substance abuse, and pursu- ing creative outlets

healthy nurse

"one who actively focuses on creating and maintaining a balance and synergy of physical, intellectual, emo- tional, social, spiritual, personal, and professional wellbeing. A healthy nurse lives life to the fullest capacity, across the wellness/illness continuum, as they become stronger role models, advocates, and educators, personally, for their families, their communities and work environments, and ultimately for their patients

Which statements if observed by nursing faculty during a mock interview by nursing students would require the nursing faculty member to intervene? Select all that apply. 1. "Where do you practice your religious beliefs?" 2. "Do you have any medical diseases that you haven't disclosed?" 3. "Are you planning to have more children?" 4. "Can you work on weekends?" 5. "Can you tell me how old you are?"

1. "Where do you practice your religious beliefs?" 2. "Do you have any medical diseases that you haven't disclosed?" 3. "Are you planning to have more children?" 5. "Can you tell me how old you are?" This question is a violation of Title VII of the Civil Rights Act 1964—individuals do not have to disclose how they practice their religious beliefs. This question is a violation of the Americans with Disabilities Act (ADA) of 1990 as the applicant does not have to disclose any pre-existing conditions during an interview. This question is a violation of Title VII of the Civil Rights Act, Pregnancy Discrimination Act (an amendment to Title VII) as it is inappropriate to ask the applicants' family planning status. Asking an interview applicant as to whether or not he or she would be available to work on weekends is an appropriate question during an interview process for it provides specific information as to the applicant's availability. This question would represent a violation of the Age Discrimination (ADEA) of 1967.

When considering implementing a traditional change theory in clinical practice, what expectations would be evident? Select all that apply. 1. Expected change would be sequential. 2. No further action is required once the change has been implemented. 3. Stakeholders must be vested in the change process. 4. The change can be applied without additional instruction. 5. In order to integrate the change, each step of the process must be completed.

1. Expected change would be sequential. 3. Stakeholders must be vested in the change process. 5. In order to integrate the change, each step of the process must be completed. Traditional change theory is based on a linear sequential sequence. To sustain change, ongoing work is required. In order for change to be effectively applied, stakeholders must share a vested interest For change theory to be integrated, instruction and work are required. Completion of each step of the process is needed to be able to integrate and maintain the change.

Which traditional change model would be indicated for a health-care organization that is looking to implement technological changes? 1. Innovation decision process 2. Force-field model 3. Phases of change model 4. Eight-stage model of creating change

1. Innovation decision process Innovative decision process is helpful when attempting to implement technological changes.

Which self-care techniques could be incorporated by a nurse to help solidify the role of a "healthy nurse"? Select all that apply. 1. Make sure that you have enough sleep and rest between shifts. 2. Focus only on individual viewpoints to frame your beliefs and practices in the clinical setting. 3. Plan to work a shift even though you are not feeling well. 4. Focus on establishing relationships that do not contain toxic people. 5. Adapt to change based on personal reflection.

1. Make sure that you have enough sleep and rest between shifts. 4. Focus on establishing relationships that do not contain toxic people. 5. Adapt to change based on personal reflection. Achieving physical self-care is a necessary component in becoming a healthy nurse. Adequate sleep and rest enable the nurse to function to best ability. Although it is important to be true to oneself, achieving mental self-care requires flexibility and open-mindedness and constant learning. Nurses should strive to achieve physical self-care but must be aware of their own limitations in providing care to others when they are not feeling well. Achieving relationship self-care requires that individuals seek to remove toxic people from one's life. Achieving emotional self-care includes the ability to change based on reflection and understanding.

Which statements are accurate with regard to preceptors or mentors? Select all that apply. 1. Preceptors serve as role models. 2. Mentors are nurses who provide instruction to their mentees. 3. The use of mentors can benefit nurses across all levels of practice and/or experience. 4. Preceptors typically are viewed as advanced beginners. 5. Mentored relationships are considered to be long term in nature.

1. Preceptors serve as role models. 3. The use of mentors can benefit nurses across all levels of practice and/or experience. 5. Mentored relationships are considered to be long term in nature. Preceptors do serve as role models by virtue of their experience and competency. A mentor is an experienced individual who may or may not be a nurse but who does want to foster a long-term nurturing environment. Mentors can benefit nurses across all levels of practice and/or experience. Preceptors are typically viewed as being competent nurses who are able to provide instruction based on experience and knowledge. Mentored relationships are viewed as being long term, whereas preceptor relationships are viewed as being more short term in nature.

What factors would help to prevent injury to nurses involved with delivery of patient care? Select all that apply. 1. Support of a "no lift" policy in the clinical facility 2. Using body mechanics properly in every lift, transfer, or positioning activity 3. Adequate staffing on units 4. Focus on manual handling as the primary method to lift, transfer, or position patients 5. Employment of ergonomic techniques

1. Support of a "no lift" policy in the clinical facility 3. Adequate staffing on units 5. Employment of ergonomic techniques

Nursing students are working together in a clinical simulation activity and being monitored by nursing faculty. Which statements if observed by nursing faculty during a clinical simulation activity with nursing students would require the nursing faculty member to intervene? Select all that apply. 1. "What do you think you are doing?" 2. "I really thought you took nursing school more seriously." 3. "What you did is so stupid that all I can do is sit here and laugh." 4. "Do you need any help?' 5. "Can you provide me with some more information?"

1. "What do you think you are doing?" 2. "I really thought you took nursing school more seriously." 3. "What you did is so stupid that all I can do is sit here and laugh." It is important to foster respectful communication in learning environments so as to maintain professionalism and promote leadership and management qualities. Statements such as "what do you think you are doing," "I really thought you took nursing school more seriously," and "What you did is so stupid that all I can do is sit here and laugh," are examples of destructive criticism. Respectful communication begins at the peer level. A student asking another student if he or she needs any help or to provide additional information is considered to be a form of respectful communication and as such would not require a faculty member to intervene.

Which percentage represents the amount of time nurse leaders and managers spend in helping to resolve conflicts within the clinical setting according to clinical research? 1. Approximately 25% 2. Varies between 50% and 100% 3. 99% 4. Less than 10%

1. Approximately 25% Current clinical research suggests that nurse leaders and managers spend about a quarter of their time attempting to resolve conflicts in the clinical setting.

Which statements describe differences between licensure and certification? Select all that apply. 1. Certification is based on meeting additional criteria as opposed to licensure, which is based on meeting minimal competency. 2. In order to become licensed, one must meet certification standards. 3. The licensure period typically lasts longer than certification periods. 4. Licensure represents general knowledge, whereas certification represents specialized knowledge. 5. Licensure is renewable as long as criteria are met, whereas certification is not renewable.

1. Certification is based on meeting additional criteria as opposed to licensure, which is based on meeting minimal competency. 4. Licensure represents general knowledge, whereas certification represents specialized knowledge. Certification is based on meeting additional criteria that are specific to specialized nursing practice areas. Licensure indicates that the nurse has met minimum competency criteria. In order to become a certified nurse, one must be licensed. The licensure period for nursing consists of a 2-year renewal, whereas certification periods typically are longer. Both licensure and certification can be renewable dependent on the individual meeting the established renewal criteria.

Which components are included in a résumé? Select all that apply. 1. Contact information for the applicant 2. A listing of personal friends résumé 3. A listing of educational degrees 4. Related work history 5. Personal preferences related to job description

1. Contact information for the applicant 3. A listing of educational degrees 4. Related work history A résumé should include contact information for the applicant, a listing of educational degrees, and related work history. It should not include a listing of personal friends or personal preferences related to the job description.

What hallmarks help to support a healthy work environment based on American Association of Colleges of Nursing (AACN)? Select all that apply. 1. Empowerment of nurses 2. Focusing on clinical advancement through educational programs 3. Fostering of collaborative relationships 4. Limiting use of technology interfaces 5. Focusing on medical executives

1. Empowerment of nurses 2. Focusing on clinical advancement through educational programs 3. Fostering of collaborative relationships Some of the hallmarks identified by AACN include empowerment of nurses, focusing on clinical advancement through educational programs, and the fostering of collaborative relationships. They also focus on advancing use of technology as well as promoting executive-level nursing leadership.

When comparing traditional change theories and models, which statements are accurate with regard to when to apply specific models? Select all that apply. 1. Force-field model when problem solving 2. Eight-stage process when rapid change is required for learning organizations 3. Force-field model when planned change is anticipated 4. Innovation-decision making when implementing technological changes 5. Phases of change when organizational change is warranted

1. Force-field model when problem solving 2. Eight-stage process when rapid change is required for learning organizations 3. Force-field model when planned change is anticipated 4. Innovation-decision making when implementing technological changes Force-field model is best used for problem solving and most situations where there is planned change. Eight-stage process is best used for rapidly changing organizations and for learning organizations. Innovation-decision making model is best used when changes in technology are anticipated. Phases of change is best used for most planned change and changing processes.

Which information is consistent with the chaos theory of change? Select all that apply. 1. It is nonlinear. 2. It contains formed matter. 3. It may also be referred to as the "butterfly effect." 4. It reflects randomness. 5. It can be predicted.

1. It is nonlinear. 3. It may also be referred to as the "butterfly effect." 4. It reflects randomness. The chaos theory of change is nonlinear in nature and represents formless matter. It may also be referred to as the "butterfly effect." As it is considered to be random, it cannot be predicted.

Which characteristic is always included when considering making changes in any type of nursing setting? 1. It is often met with resistance. 2. It does not lead to conflict. 3. As long as stakeholders are vested in the process, there will be no problems with implementation. 4. All changes lead to improved outcomes.

1. It is often met with resistance. When considering any change, there is always the potential for it to be met with resistance, be difficult, and lead to conflict. These characteristics can occur even in the presence of stakeholders who are vested in the process. Not all changes lead to improved outcomes.

Which characteristic is not attributed to Emerging Change Theories? 1. Linear in nature 2. Inherent complexity 3. Exhibit flexibility 4. Focus on innovation

1. Linear in nature Emerging Change Theories are cyclical in nature rather than linear. They are complex, flexible in nature, and focus on innovation.

A nursing student who is going to graduate from a Bachelor of Science Nursing (BSN) program is preparing a résumé. What fact should the nurse pay attention to when preparing the document? 1. Most employers who read résumés spend little time reviewing the document. 2. All activities should be included in the document regardless of whether they relate to the job position. 3. The document should be presented in a comprehensive narrative format. 4. Language style used is not important.

1. Most employers who read résumés spend little time reviewing the document. Based on documented research, most nurse leaders and managers spend about 30 seconds reviewing a typical résumé. Not all activities should be included in the document. The document should be written in a concise format. Language style is important.

Which action would contribute to nurse fatigue in a staff nurse who is working a 12-hour shift on a medical unit and who has been assigned to take care of five patients based on a primary care model? 1. Nurse eats lunch meal at the nurse's station while answering unit phone 2. Nurse leaves the unit on time at the end of the scheduled shift 3. Nurse does not sign up for additional shifts to cover unit vacancies 4. Nurse states she typically sleeps 8 hours a night

1. Nurse eats lunch meal at the nurse's station while answering unit phone A nurse should be able to take a break and relinquish care in order to get the best benefit from a rest period.

In the clinical setting, the hospital organization has changed to a different electronic health record (EHR) system after reviewing several different types of available systems. Of what type of change is this an example? 1. Planned change 2. Unplanned change 3. Innovation 4. Crisis resolution

1. Planned change This is an example of a planned change based on a systematic analysis of available systems. Unplanned change occurs when either there is a subtle need or in response to a crisis. Innovation is an example of change that addresses something new or creative. Since the organization is switching from one type of EHR to another, this would not be an innovative change. Since the change is anticipated and planned, this would not be a response to a crisis.

Which characteristic is included in the American Nurses Association (ANA) Nurses' Bill of Rights? 1. To function as a patient/client advocate without fear of retribution 2. Compensation for clinical practice is based solely on the fiscal budget of the employer 3. Practice setting safety addresses patient/client only 4. Negotiation for conditions of employment is not included as a basic right

1. To function as a patient/client advocate without fear of retribution According to ANA Nurses' Bill of Rights, nurses are expected to function as advocates for both themselves as well as their patients/clients without fear of retribution. Nurses have the right to fair compensation for their work, consistent with knowledge, experience, and professional responsibilities. While the fiscal budget of the employer may affect the ability to determine a salary schedule, fair compensation based on the noted criteria is the position held by the ANA. Practice setting safety according to the ANA Nurses' Bill of Rights is for both nurse and patient/client. According to ANA, nurses have the right either individually or collectively to negotiate conditions of employment.

A worker on the nursing unit has become increasingly frustrated with the work environment and is becoming more aggressive with the rest of the staff. How would this be classified according to the National Institute for Occupational Safety and Health (NIOSH)? 1. Type 3 2. Type 1 3. Type 2 4. Type 4

1. Type 3 Type 3 refers to the perpetrator being a co-worker and who commits violence on another co-worker. Type 1, the perpetrator has no criminal intent and no relationship with the individual or organization. Type 2, the perpetrator is the customer (consumer) and/or family member who has a relationship with the organization while receiving services. Type 4, the perpetrator has a relationship with the worker that is personal but has no relationship with the organization.

What factors would help to contribute to nurses being injured during delivery of client care? Select all that apply. 1. Implementation of manual lifting 2. Two-person lift 3. One-person lift 4. Hook-and-toss method 5. Discontinuing "no lift" policy

1.Implementation of manual lifting 3. One-person lift 5. Discontinuing "no lift" policy Implementation of manual lifting over time can cause microinjuries to the spine. A one-person lift can also lead to a nurse being injured during delivery of client care. It is important to have adequate resources available in terms of personnel as well as equipment to facilitate lifting. Evidence-based practice suggests that the "no lift" policy be continued and supported in the clinical environment. American Nurses Association (ANA) supports the implementation of a "no lift" policy in clinical facilities in order to maintain nurse safety. A two-person lift and the hook-and-toss method are considered to be acceptable techniques for lifting.

Which behaviors are considered to be common human responses to change? Select all that apply. 1. Universal equivocal acceptance 2. Adjustment period needed 3. Resistance 4. Feeling threatened by the change 5. Not needing further explanations

2. Adjustment period needed 3. Resistance 4. Feeling threatened by the change With change, some resistance is commonly seen. It is rare to have universal equivocal acceptance in response to change. A common human response to change is to have an adjustment period in which time one can work through, adapt, and integrate the change. Resistance can be a common human response to change for an individual may feel that no change is necessary in order to maintain the status quo. Feeling threatened by a change is a common human response. In order for change to be effective, additional feedback and explanations can help facilitate and integrate the change.

Nurses on a medical-surgical unit are reluctant to suggest any changes at a staff meeting as to how policies and procedures are implemented on the unit because in the past, the nurse manager has listened but not included any of their suggestions and just places her own ideas to direct change. The nurse manager views this process as being evidence of compromise, but the staff does not feel that this has occurred. What type of conflict are the staff nurses experiencing? 1. Avoiding 2. Competing 3. Compromising 4. Collaborating

2. Competing As a decision has been made, avoidance is not being exhibited as a conflict management strategy. Since the nurse manager is placing her own ideas without accepting input from staff members, this would be an example of competing. Since the nurse manager is placing her own ideas without accepting input from staff members, this would be an example of competing. Compromise would involve each side giving and taking to arrive at a decision. Since the nurse manager is placing her own ideas without accepting input from staff members, this would be an example of competing. Collaboration would involve listening and including decision making from both staff and nurse manager to effect change. Since the nurse manager is placing her own ideas without accepting input from staff members, this would be an example of competing.

A panel of nurses, both staff and management, has been asked to participate on an interview committee for a nursing position that has become available on a medical-surgical unit. Which option would take priority in helping to focus the committee on the task at hand? 1. Determining the amount of time that will be assigned for each applicant 2. Developing an understanding of the job description 3. Determining how many years each applicant has been in the nursing profession 4. Understanding the experience of each applicant

2. Developing an understanding of the job description Understanding the job description frames the basis for the interview process for it identifies the roles and responsibilities for the position.

Which characteristics are attributed to emerging change theories? Select all that apply. 1. Are linear in nature 2. Have inherent complexity 3. Exhibit flexibility 4. Can be classified as simplistic and cyclical in appearance 5. Are dynamic

2. Have inherent complexity 3. Exhibit flexibility 5. Are dynamic Traditional change theories are linear in nature. Emerging change theories are best described as being complex in nature. Emerging change theories are flexible and cyclical. Although emerging change theories are cyclical, they are not simplistic but rather they exhibit complexity. Emerging change theories are based on dynamic context.

Which measures would help to reduce stress levels experienced by new graduate nurses? Select all that apply. 1. Graduation from an accredited nursing program 2. Inclusion of a nurse residency program 3. Utilization of unit-specific orientations 4. Anticipation that the new graduate nurse is ready to assume the role of a registered nurse (RN) in clinical practice 5. Incorporation of education as well as clinical training

2. Inclusion of a nurse residency program 3. Utilization of unit-specific orientations 5. Incorporation of education as well as clinical training Although accreditation serves as a critical standing in nursing education, the fact that a student has graduated from an accredited program does not have a direct correlation in reducing stress in the new graduate nurse. Research has demonstrated that a nurse residency program leads to decreased stress in the new graduate nurse. Research has demonstrated that even upon graduation from an accredited nursing program, the "new" graduate nurse has a learning curve when applied to being able to assume the role of an RN. Comparison of actual versus expected results would occur in the evaluation phase. Incorporating education as well as clinical training will help to reduce stress in the new graduate nurse.

Which action by a nurse manager would be viewed as a barrier to change in the clinical setting? 1. Instilling confidence in staff by acknowledging competence 2. Limiting communication among members of staff 3. Allowing staff members to apply for another job in the facility 4. Fostering a collaborative approach among staff

2. Limiting communication among members of staff Limiting communication would be seen as a barrier to change. It is important to keep communication open in order to foster adaptive and integrative responses to change.

A group of new graduate nurses are discussing what they will do following graduation. One of the new graduate nurses has identified that she will focus her clinical practice pathway in hospital-based bedside nursing as that was what her family had expected her to do upon graduation. What type of future is demonstrated by this statement? 1. Preferable 2. Plausible 3. Possible 4. Probable

2. Plausible Preferable future relates to a vision of what will be and a road map design to achieve it. The new nursing student is basing her future on what has occurred in the past. Plausible future relates to what has previously occurred based on current information. The new nursing student is basing her future on what has occurred in the past. Possible future relates to considering all possibilities and leads to seeking the preferable future. The new nursing student is basing her future on what has occurred in the past. Probable future relates to what will occur based on minimal change. The new nursing student is basing her future on what has occurred in the past.

Which activity would indicate reflective learning? 1. Meeting learning objectives in a nursing course 2. Seeking opportunities for improvement 3. Completing a continuing education (CE) activity 4. Making sure that all requirements for license renewal have been satisfied

2. Seeking opportunities for improvement Seeking opportunities for improvement is an example of reflective learning for it is based on self-analysis of strengths and weaknesses.

Nursing managers have asked nursing staff to participate in a discussion relative to maintaining a quality workforce within the nursing unit and health-care facility. What methods would help to support this goal? Select all that apply. 1. Formalize operations so that nursing staff in order to perform their work must be dependent on nursing management. 2. Set excellence as a consistent goal for both nursing staff and nurse managers, 3. Set up a series of expectations among stakeholders with limited accountability, 4. Arrange for job positions where nurses and managers can use their expertise as the basis for selection, 5. Encourage open communication between management and staff,

2. Set excellence as a consistent goal for both nursing staff and nurse managers, 4. Arrange for job positions where nurses and managers can use their expertise as the basis for selection, 5. Encourage open communication between management and staff Best practice would be to have a collaborative relationship between nursing staff and nurse managers so that workplace autonomy could be promoted. A dependent relationship for performance of work will limit productivity and possibly delay delivery of care. The pursuit and attainment of excellence help to promote and maintain a quality workforce. Although expectations should be clearly defined, members of the workforce should take accountability for their actions. Matching competencies and skill sets of employees leads to development of a quality workforce. Facilitating communication between management and staff will lead to increased collaboration.

A nurse observes a nurse and patient having a loud conversation. The nurse is yelling at the patient and is pointing a raised finger at the patient stating that "he'd better behave." How would the nurse who is observing this interaction categorize this type of behavior in terms of violence? 1. Lateral 2. Third party 3. Vertical 4. Horizontal

2. Third party Because this behavior is occurring between a nurse and a patient and is being observed by another nurse, this would be an example of third-party violence.

Which aspect of change takes place in the refreezing stage of Lewin's Force-Field Model? 1. Determination that change is needed 2. Achievement of equilibrium 3. Exhibiting motivation to change 4. Gathering of information occurs

2. Achievement of equilibrium In the refreezing stage of Lewin's Force-Field Model, the change is stabilized, and equilibrium is restored. Determining that change is needed along with exhibiting motivation to change take place in the unfreezing stage. Gathering of information takes place in the moving stage.

What standards help to support a healthy work environment based on the American Association of Critical Care Nurses? Select all that apply. 1. Closed-ended communication 2. Adequate staffing 3. Standards established that are independent 4. True collaboration 5. Authentic leadership

2. Adequate staffing 4. True collaboration 5. Authentic leadership The American Association of Critical Care Nurses created interdependent standards that reflect adequate staffing, true collaboration, and authentic leadership. Also included in the standards are skilled communication, effective decision making, and meaningful recognition.

Which statements are true with regard to continuing education (CE) credit requirements for registered nurses? Select all that apply. 1. CEs are not required once the nurse has achieved licensure. 2. CE requirements may vary from state to state. 3. It is the individual nurse's responsibility to continue to take CEs. 4. CEs are limited in how they are presented. 5. CEs courses are accredited.

2. CE requirements may vary from state to state. 3. It is the individual nurse's responsibility to continue to take CEs.. 5. CEs courses are accredited. CE requirements vary from state to state. Maintaining CEs is the responsibility of the individual nurse throughout his or her career. Professional organizations such as the American Nurses Credentialing Center accredit CE courses. CE courses can be offered in a variety of modalities.

Which statement is accurate with regard to the Phases of Change Model? 1. Change always occurs in a comprehensive manner. 2. Communication and feedback are critical elements. 3. Time does not affect potential for change. 4. Realistic goals are often not achieved.

2. Communication and feedback are critical elements. Communication and feedback are critical elements that exist within all aspects of the Phases of Change Model. Change occurs typically in a sequential manner rather than as a comprehensive event. Time affects potential for change in all aspects of the model. For change to be effective and maintained, goals must be realistic.

Staff nurses in response to a suggested change on the unit have displayed no resistance and are embracing the change. Which example of change strategy is represented by this scenario? 1. Normative-reeducative 2. Empirical-rational 3. Power-coercive 4. Anticipated due to peer pressure

2. Empirical-rational Individuals who accept and embrace the change are displaying empirical-rational change strategy. In a normative-reeducative change strategy, change would be mediated by peer pressure and the desire to have satisfactory work relationships. In a power-coercive change strategy, change is based on power and authority.

Which behaviors if utilized by nurse managers would help to establish change in the clinical environment? Select all that apply. 1. Rewarding consistent actions at the expense of anticipated change 2. Helping to build trust 3. Instilling confidence 4. Anticipating that change is inevitable 5. Not allowing staff to transfer off unit

2. Helping to build trust 3. Instilling confidence 4. Anticipating that change is inevitable A nurse manager would help to establish change in the clinical environment by helping to build trust, instilling confidence and anticipating that change is inevitable. Although rewarding consistent actions is appropriate, it should not be done at the expense of anticipated change, as it would instill acceptance of resistance. Not allowing staff to transfer off unit would not establish change in the clinical environment. A nurse manager should help to support the careers of his or her staff by allowing job movement.

Nurses in the emergency room (ER) are complaining about how the medical-surgical unit nurses are responding to them when patients are being transported to the floor. The ER nurses state that the medical-surgical nurses do not want to do their job at times. The medical-surgical unit nurses state that the ER nurses always bring the patients near change of shift. What type of conflict is represented by this situation? 1. Interpersonal 2. Intergroup 3. Organizational 4. Intrapersonal

2. Intergroup The situation represents intergroup conflict, which is typically seen between groups of people, in this case, different hospital departments. Interpersonal conflict is when a disagreement exists between individual people within a defined group setting. Organizational conflict represents a disagreement between staff and organizational policies and procedures. Intrapersonal conflict exists within the individual in response to a situation.

Which employment option would be most beneficial for a new graduate nurse who has just passed state boards and is newly licensed as a registered nurse? 1. Orientation training lasting 30 days for a position in an ambulatory care surgical unit 2. Medical-surgical unit with orientation training lasting 6 months inclusive of self-review and core competencies 3. Intensive care unit preceptorship lasting 60 days 4. Orthopedic unit with no structured orientation process 5. Medical oncology unit with orientation lasting 6 weeks with no assigned preceptor

2. Medical-surgical unit with orientation training lasting 6 months inclusive of self-review and core competencies Transition to practice (TPP) programs are advocated in order to retain new graduate nurses in the workplace. Best evidence practice suggests that these programs must be at least 6 months long, include core competencies, clinical reasoning, and regular feedback on progress, self-reflection, and specialty knowledge in a practice area so as to improve quality and safety and most importantly lead to job satisfaction and job retention. Orientation periods lasting less than 6 months are not advocated (30 days or 60 days) regardless of the type of job position that is being offered in training. Having no structured orientation process would not be beneficial to support professional growth, quality, and safety concerns. Having no assigned preceptor would place undue stress on the new graduate nurse.

Which statement reflects the difference between a preceptor and a mentor? 1. Preceptors provide a lifelong learning relationship, whereas mentors provide shorter-term learning relationships. 2. Mentors do not have to be nurses but preceptors do. 3. A mentoring relationship exists only at the beginning graduate nurse level, whereas preceptors occur across experience levels. 4. It is the type of communication pattern that is maintained.

2. Mentors do not have to be nurses but preceptors do. Mentors do not have to be nurses, whereas preceptors do have to be nurses. Mentors provide a lifelong learning relationship, whereas preceptors provide shorter-term learning relationships. Preceptors typically interact with beginning graduate nurses, whereas mentors interact with nurses across experience levels. Both mentors and preceptors use similar communication patterns in order to maintain their relationships.

Based on Benner's novice to expert model, which nurse would best serve as a preceptor for a new graduate nurse who is starting the orientation process on a medical-surgical unit and has no prior clinical experience other than nursing school clinical experience? 1. Charge nurse on the unit with 20 years of experience on that unit 2. Nurse who has just gotten off orientation but has been a nurse for about 5 years 3. Nurse who has worked on the unit for 10 years with a varied clinical background including medical-surgical, pediatrics, and obstetrics 4. Nurse who recently transferred from a different unit in the facility with 15 years of experience in the areas of critical care and medical-surgical settings

2. Nurse who has just gotten off orientation but has been a nurse for about 5 years Best practice evidence suggests that a nurse who is considered to be competent would be effective in serving as a preceptor because the nurse would be able to differentiate and organize tasks while still displaying empathy to those individuals who are emerging as novices and advanced beginners. Nurses with many years of experience (10, 15, and 20), although extremely qualified, may not function as the best preceptors, for their analytical skills lead to completion of tasks rather than allowing for new nurses to gain knowledge as part of the learning process. Experienced (proficient) nurses may seek completion rather than provide ongoing feedback as needed to assist novice and/or advanced beginners in their quest to become proficient.

A group of nurses are working on an obstetrical unit and are discussing how the Nurses' Bill of Rights can be incorporated into the day-to-day operations of the nursing unit. Which suggestion could be implemented that would reflect compliance? 1. Protocols on nursing unit are based on physician preference. 2. Nurses act as patient advocates. 3. Compensation for work is based on personal preference recommendations of management. 4. Nurses are not involved in collective bargaining conversations.

2. Nurses act as patient advocates. Nursing staff should advocate for both themselves as well as patients who are under their care.

In a hospital setting, there appears to be conflict between the hospital's administrative personnel regarding hospital performance objectives. What type of conflict could be applied to this situation? 1. Intrapersonal 2. Organizational 3. Interpersonal 4. Intergroup

2. Organizational Organizational conflict exists when there is disagreement related to policies and procedures at the institutional level. Intrapersonal conflict seen within an individual who is having difficulty with a situation is viewed as an internal process. Interpersonal conflict exists when there is a disagreement between two or more individuals. Intergroup conflict exists at the department level where entire groups have a disagreement.

Which information should not be included in a cover letter? 1. Should serve as an introduction 2. Quotes from references 3. Reason why you are applying for the position 4. Brief summary of qualifications

2. Quotes from references Cover letters should not include quotes from references, but rather the cover letter serves as an introduction of the nurse to the prospective employer. The reason for why you are applying for the position should be included along with a brief summary of qualifications.

Which information is represented by the framed question, "why" of change? 1. Participant stakeholders 2. Rationale 3. Timing 4. Technique

2. Rationale Rationale is represented by the framed question, "why" of change. Participant stakeholders are represented by the framed question, "who" of change. Timing is represented by the framed question, "when" of change. Technique is represented by the framed question, "how" of change.

In a corrective plan of action, which violations would warrant documenting a written reprimand? Select all that apply. 1. First 2. Second 3. Third 4. Fourth 5. All violation classes

2. Second 3. Third 4. Fourth A written reprimand would be indicated in the second, third, and fourth stages of a corrective action plan. During the first stage, the process is informal with verbal discussion of the issue.

Which self-care area is included in helping nurses to limit fatigue in the clinical setting? 1. Educational 2. Spiritual 3. Flexible 4. Individual

2. Spiritual Identified self-care areas that would help the nurse to limit fatigue in the clinical setting are spiritual, physical, mental, emotional, relationship, and choice.

Which statement is inaccurate with regard to work-related injuries and illness? 1. Health-care workers are more likely to experience work-related injuries and illness. 2. Stress does not play a role in work-related injuries and illness. 3. Musculoskeletal complaints are typically seen. 4. Working overtime appears to lead to more work-related injuries and illness.

2. Stress does not play a role in work-related injuries and illness. Current research has shown that health-care workers have a higher incidence of work-related injuries and illness. This in part can be due to acute and chronic effects of stress and overwork. The most common reported disability is musculoskeletal injuries.

Which behavioral action by a charge nurse would indicate an example of destructive feedback if observed in a clinical setting relative to a nurse's performance? 1. Offering the nurse a set of sterile gloves upon witnessing that the gloves that the nurse is wearing to perform a procedure have a tear 2. Telling the nurse that you have never seen anyone do that in all your years of nursing experience in front of a patient 3. Asking the nurse to provide more detailed information related to the patient's pain assessment 4. Telling the nurse that she is getting the next admission to the floor

2. Telling the nurse that you have never seen anyone do that in all your years of nursing experience in front of a patient Telling the nurse that you have never seen anyone do that in all your years of nursing experience in front of a patient is an effort to humiliate the nurse. As stated, it fosters an atmosphere of distrust and as such would be considered to be destructive. Offering the nurse another set of sterile gloves would be viewed as being helpful and supportive. Asking the nurse to provide additional information to help clarify a patient's assessment is necessary to provide quality care. Telling the nurse that she is getting the next admission to the floor is part of patient assignment and within the role of a charge nurse.

The nurse leader is developing a quality improvement (QI) project for the nursing unit and knows that what characteristics are necessary to determine the priority of the issue to be investigated? Select all that apply. 1. Failure in performance is known to occur infrequently. 2. The problem itself occurs frequently. 3. The problem has at some time caused serious consequences to health. 4. The problem has caused issues that are costly. 5. The problem may be very difficult to fix.

2. The problem itself occurs frequently. 3. The problem has at some time caused serious consequences to health. 4. The problem has caused issues that are costly. Characteristics for determining priority are that the problem occurs frequently, a failure in performance is known to have serious consequences to health, and a problem must be easily corrected, not be difficult to fix. To determine priorities, the error or failure in performance is believed to occur frequently, not infrequently. To be considered a priority, a failure in performance is known to have costly consequences.

Which statement indicates the primary purpose for Nurse Residency programs? 1. To decrease the stress level for new graduates 2. To provide a transition program that leads to competent practice 3. To allow for new nurses to learn basic information 4. To provide continuing education credits for initial licensure

2. To provide a transition program that leads to competent practice The primary purpose for Nurse Residency programs is to provide a transition pathway that leads to competent practice in the workforce. Although it may help to decrease stress experienced by new graduate nurses, this is not the primary purpose. It is not a way for nurses to learn basic information or a method to provide continuing education credits for initial licensure.

A nurse who has been licensed for 2 years is now seeking employment at a different facility. Which option would the nurse consider to be a priority with regard to potential employment at this other facility? 1. Number of beds in the hospital facility 2. Understanding of the nursing job description being offered 3. Whether the hospital is considered to be a teaching facility 4. Whether the hospital has achieved Magnet status

2. Understanding of the nursing job description being offered With regard to employment, the critical factor is for the applicant to understand the posted job position, for this will outline specific duties and responsibilities associated with the nursing position. Number of beds is not considered to be a priority with regard to employment, but it can affect the applicant's decision-making process as to whether or not he or she has a preference relative to facility size. Additionally, whether or not the hospital is a teaching facility or has achieved Magnet status may affect the applicant's decision-making process but is not a priority with regard to potential employment.

A nurse manager is viewed by the nursing staff as exhibiting avoidance behavior relative to any identified conflict on the unit. What type of conflict management strategy is being displayed? 1. Accommodating 2. Competing 3. Avoidance 4. Collaborating

3. Avoidance The nurse manager is displaying avoidance, which does not resolve the conflict but rather allows for the conflict to re-emerge at a later date.

Which research evidence supports the Institute of Medicine (IOM) mandate of 2020 to support the growth of baccalaureate (BSN) prepared nurses? 1. Associate degree nursing programs are not needed. 2. Medication errors by nurses have increased, regardless of the nurses' educational level. 3. Better patient outcomes have been realized with BSN nurses. 4. No difference in length of stay (LOS) for patients is seen regardless if taken care of by nurses with different educational backgrounds.

3. Better patient outcomes have been realized with BSN nurses. Decreased morbidity and mortality are seen in patient outcomes if they are taken care of by BSN nurses.

Which actions should nurse leaders and managers take that would foster a healthy work environment in the clinical setting? Select all that apply. 1. Identify specific roles and responsibilities of nursing staff with narrow functions. 2. Limit availability of continuing education resources available for nursing staff. 3. Create an interdisciplinary team approach to manage and deliver patient care. 4. Only involve charge nurses and nurse managers in clinical decision making. 5. Encourage staff to attain additional certification in their chosen specialty area.

3. Create an interdisciplinary team approach to manage and deliver patient care. 5. Encourage staff to attain additional certification in their chosen specialty area.

Which actions would directly affect nurses' participation in clinical decision making within a clinical care system? Select all that apply. 1. Reimbursement for educational programs 2. Centralized framework structure 3. Inclusion in hospital committees 4. Utilization review of established practices on nursing units by nursing staff 5. Provision of incentive programs for nurses who are interested in furthering their education

3. Inclusion in hospital committees 4. Utilization review of established practices on nursing units by nursing staff Including nurses as members of hospital committees facilitates participation in clinical decision making. Clinical decision making is enhanced when nurses are active in the utilization review process and self-analysis of nursing practices.

A nursing student who is going to graduate from a Bachelor of Science Nursing Program (BSN) is preparing a résumé. Which notation should not be included? 1. Educational background 2. Volunteer history 3. Interest in position 4. Awards or certification

3. Interest in position The individual's interest in the position should be included in the cover letter that will accompany the resume.

In a hospital setting, there appears to be conflict between two nurses, one who works in the emergency department and the other who works in the operating room. What type of conflict could be applied to this situation? 1. Intrapersonal 2. Organizational 3. Interpersonal 4. Intergroup

3. Interpersonal Interpersonal conflict exists when there is a disagreement between two or more individuals.

A nurse who has been working at a health-care facility for 5 years on a medical-surgical unit is thinking of applying for a transfer to another unit. Which statement would indicate that the transfer application is based on an issue that did not support a healthy work environment? 1. Desire for advancement 2. Increase in compensation 3. Limited mentoring opportunities 4. Recognition by management

3. Limited mentoring opportunities A healthy work environment would foster a desire for advancement. An increase in compensation is a factor that would contribute to a healthy work environment. Limited mentoring opportunities would not support a healthy work environment. Recognition by management would foster a healthy working environment.

Which situations would help to promote a healthy work environment in the clinical setting? Select all that apply. 1. Staff nurses complain of fatigue with having to work additional hours 2. The nurse manager has received complaints of bullying occurring on the unit arising from one staff member 3. Nurses perceive that a culture of physiological safety exists on the nursing unit 4. Staff adhere to the American Nurses Association (ANA) Nurses Bill of Rights as part of nursing unit policy 5. Staff feel that their efforts are valued by management

3. Nurses perceive that a culture of physiological safety exists on the nursing unit 4. Staff adhere to the American Nurses Association (ANA) Nurses Bill of Rights as part of nursing unit policy 5. Staff feel that their efforts are valued by management The perception of physiological as well as psychological safety by the nursing staff represents a healthy work environment. Adherence to the ANA Nurses Bill of Rights represents compliance with designated rights to help promote a healthy work environment. Staff that feels that their actions are valued by management is representative of a healthy working environment.

A medical-surgical unit has added three new RNs to their night shift. Based on Benner's novice to expert model and observations from the National Council of State Board of Nursing (NCSBN), what would the nurse manager expect to see from these new graduate nurses as they begin their orientation on the nursing unit? 1. Competent care based on observations correlated with didactic information. 2. Proficiency in all demonstrated clinical skills 3. Performance at a novice and/or advanced beginner level 4. Formulation of actions without regard to assessment findings

3. Performance at a novice and/or advanced beginner level The expectation is that new graduate nurses would function at the novice and/or advanced beginner level.

Which nursing action reflects a culture of competence? 1. A student nurse reads only what is required for classroom assignments. 2. A staff nurse does not attend clinical in service on unit due to her own evaluation of established clinical judgement. 3. Staff nurses on the unit all sign up for a physical assessment class to review procedures and policies. 4. A graduate nurse who has recently become licensed is waiting to meet continuing education requirements until her license is due to be renewed to prevent distraction from being oriented to her new role as a registered nurse.

3. Staff nurses on the unit all sign up for a physical assessment class to review procedures and policies. All staff nurses on the unit signing up to attend a class is an example of providing an atmosphere to facilitate continued learning.

A nursing instructor is preparing to use 360-degree feedback to help a group of nursing students gain feedback from their recent clinical experience on a medical-surgical unit. How does 360-degree feedback differ from a traditional peer review process? 1. The peer review process is constructive, whereas 360-degree feedback is destructive 2. The 360-degree feedback is used primarily for managers, whereas peer review is aimed at staff or student-level nurses 3. The 360-degree feedback is usually presented anonymously based on a collection of input, whereas the peer review process represents a more structured approach. 4. Traditional peer review is based on a collected summary from participants, whereas 360-degree feedback is based on individual feedback.

3. The 360-degree feedback is usually presented anonymously based on a collection of input, whereas the peer review process represents a more structured approach. The 360-degree feedback is typically done anonymously with the information collected and summarized by the nurse manager or leader, and then the information is presented to the participant members.

In a corrective plan of action, which violations would warrant contacting the human resources department? Select all that apply. 1. First 2. Second 3. Third 4. Fourth 5. All violation classes

3. Third 4. Fourth The human resources department is contacted only when the situation has risen to a level where there have been repeated prior contacts between the employer and the employee with no positive resulting behavioral change. In prior violation categories, the focus is on communication, first verbal and then written between the employer and the employee.

A nurse manager is going to develop a corrective action plan for a nursing staff member. What is the primary focus of a corrective action plan? 1. To initiate the termination process for an employee 2. To identify destructive behavior and actions 3. To identify the underlying reason 4. To provide constructive feedback

3. To identify the underlying reason Determining the reason for the substandard performance is the primary focus for establishing a corrective action plan.

Emerging trends in labor statistics data have reported that nurses are continuing to work as they age. What would nurse managers and leaders suspect based on this information? 1. The majority of older nurses will never retire. 2. There is no need to modify the work environment for older nurses. 3. Utilize flexibility in scheduling. 4. Older nurses will be less effective as mentors.

3. Utilize flexibility in scheduling. Although nurses are continuing to work longer, the majority of nurses will eventually retire. Environmental modification is a necessary component in assisting the older nurse to continue working in the clinical setting. Utilizing flexibility in scheduling will help to assist older nurses as they continue to work in the clinical setting. The strength of a mentor relationship is defined by the experience and quality of the mentor and not by one's age.

A nursing unit is being educated on methods to prevent workplace violence from occurring on the nursing unit. Which statement by a nursing staff member indicates that adequate instruction has been provided? 1. "I will work on maintaining a culture of incivility." 2. "The responsibility for whether or not workplace violence occurs rests with management." 3. "I will remain accountable for all of my behaviors and actions while working on the nursing unit." 4. "I will keep to myself and focus only on my immediate environment while at work."

3. "I will remain accountable for all of my behaviors and actions while working on the nursing unit." Taking accountability for one's actions and behaviors will increase self-awareness as to maintain collegial relationships.

Which statement by a nursing staff member indicates that incivility has occurred on the nursing unit? 1. "I wish that I didn't have to take that assignment." 2. "I always end up staying late to complete my documentation and that makes me upset." 3. "They seem to keep hiring the same type of people here, those who don't want to work and then I have to keep doing their job." 4. "I respect my nurse manager but I don't like her as a person."

3. "They seem to keep hiring the same type of people here, those who don't want to work and then I have to keep doing their job." Incivility includes statements that are rude and disrespectful as they relate to others. Incivility may also include gossiping, spreading rumors about co-workers, and refusing to work with co-workers. In this situation, the nursing staff member's comments have made a statement that is rude and disrespectful as it is applied to others. Not wanting to take an assignment does not represent incivility. Admitting to having to stay late to complete documentation and being frustrated do not represent incivility. Indicating that one has respect for a supervisor but does not personally like him or her is an admission of personal opinion.

Which statement best describes what is meant by the term "third-aged nurses"? 1. Refers to individuals who already had a professional career and then went back to school to obtain a nursing license and pursue a nursing career 2. Nurses who have three academic degrees 3. A nurse who is within the age group of 50 to 70 years 4. Nurses who work three 12-hour shifts to satisfy their work week requirement

3. A nurse who is within the age group of 50 to 70 years The third-aged paradigm refers to individuals who are within the age group of 50 to 70 years. Therefore, third-aged nurses would be nurses who fall into this age category. Individuals who go back to school to attain a nursing degree and license are not referred to as third-age nurses. There is no correlation between nurses who have three academic degrees or nurses who work three 12-hour shifts to satisfy their work requirement and third-aged nurses.

Which information should be included in a nurse's self-appraisal? Select all that apply. 1. A listing of personal hobbies 2. Salary 3. A review of goal statements 4. Accomplishments achieved during the last year 5. Peer feedback received

3. A review of goal statements 4. Accomplishments achieved during the last year 5. Peer feedback received A self-appraisal should include a review of goal statements, accomplishments achieved during the last year, and peer review feedback. The self-appraisal should reflect a review of past performance related to specific goals and accomplishments. It does not include a listing or personal hobbies and/or salary information.

Which behavioral action if observed by a nurse leader would indicate effective coaching style? 1. Providing constant feedback 2. Keeping a low profile while looking toward inner self-reflection 3. Acknowledging a job that is well done 4. Focusing only on achievement of personal gain

3. Acknowledging a job that is well done Characteristics of an effective coach include acknowledging a job that is well done. Providing constant feedback is not an example of an effective coaching style but rather providing constructive feedback when necessary is. Keeping a low profile while looking toward inner self-reflection does not inspire or foster confidence as a motivator or leader. Focusing only on achievement of personal gain rather than focusing on achievement of organizational goals would not be considered to be an effective coaching style.

Which certification degree represents an acute care nurse practitioner? 1. Adult health clinical nurse specialist 2. Informatics nursing 3. Adult psychiatry, mental health 4. Nurse executive—advanced

3. Adult psychiatry, mental health Adult psychiatry, mental health, is an example of a certification degree for an acute care nurse practitioner. Adult health clinical nurse specialist is an example of a clinical nursing specialist certification. Informatics nursing and nurse executive—advanced are examples of specialty certifications.

A nurse is reviewing her annual performance appraisal from her direct supervisor (Unit Nurse Manager) and does not agree with some of the information documented on the form. How should the nurse respond to this noted disagreement? 1. Sign the form as indicated and then talk to the chief nursing officer of the facility. 2. Do not sign the form and ask for a copy so that you can bring it home to discuss it with your family. 3. Discuss your concerns with your direct supervisor and make noted comments on the form stating that you disagree and then sign the form. 4. Sign the form indicating that you agree because there are no designated restrictions on your role on the unit and this is just personally motivated.

3. Discuss your concerns with your direct supervisor and make noted comments on the form stating that you disagree and then sign the form. Each individual has the right to agree or disagree with an annual performance appraisal. As such, if disagreement is noted, the nurse should discuss relevant concerns with her direct supervisor, provide comments on the form itself, and then designate a signature. Signing the form without addressing the noted disagreement is not considered to be a prudent action. In terms of chain of command, best practice is to discuss matters with one's direct supervisor before going up the chain of command to the chief nursing officer of the facility. While one can always ask for a copy of the form, not signing the form is not considered to be a prudent action. On every performance appraisal form, there is a designated section that indicates that the employee can note agreement or nonagreement as well as provide additional information. Signing the form indicating agreement when you have identified a disagreement is not considered to be a prudent action regardless of whether or not there are any restrictions placed on your employment role.

What action would help to promote workforce sustainability in a hospital setting? 1. Nurse managers hiring new employees to fill positions regardless of whether they have clinical experience 2. Allowing nursing staff to work overtime 3. Facilitating an open communication pattern 4. Nurse managers maintaining fiscal responsibility in budget planning

3. Facilitating an open communication pattern Open communication along with creating a positive environment will help to promote workforce sustainability. Hasty hiring practices will do little to improve morale or assist in providing quality care. Allowing nursing staff to work overtime is an independent factor and as such does not directly contribute to promoting workforce sustainability. Nurse managers maintaining fiscal responsibility in budget planning is also an independent factor and as such does not directly contribute to promoting workforce sustainability.

The nurse manager is providing a performance appraisal to one of the nurses on the unit who has not received a very good evaluation. The nurse manager is offering constructive criticism to help the nurse gain insight into how improvement can be made. Which action by the nurse manager would be included in a performance appraisal? 1. Telling the nurse that it would be helpful if when talking to other staff members on the unit, the nurse used a lower tone of voice 2. Inquiring about the nurse's family members before starting to discuss the performance appraisal 3. Focusing on aspects of the job description where improvement is needed 4. Telling the nurse that it would be better to only share comments/concerns with management

3. Focusing on aspects of the job description where improvement is needed With regard to a performance appraisal, the focus should be on the employee's demonstrated work according to specified standards outlined in the job description for that position. Discussing personality characteristics should not be addressed during a performance appraisal, and nor should inquiry be made about the nurse's family members. Telling the nurse that it would be better to only share comments/concerns with management is not an example of open communication and as such limits the employees from exercising free speech.

Despite best efforts, it has been decided that a nurse is to be terminated based on several recorded action plans without noted improvement or correction of incidents. The nurse manager and the chief nursing officer of the facility are in agreement that the employee meets the criteria for termination. Which department in the facility should also be included in review of the termination procedure? 1. Hospital Ethics Committee 2. Medical staff 3. Human Resources 4. Clinical Nurse Educator

3. Human Resources It would be helpful to contact the Human Resources department so that a review of supportive documentation is in order for compliance with termination procedures of the parent institution. Contacting the Hospital Ethics Committee would only be indicated if there was an ethical violation that affected patient care. There is no need to contact the medical staff in this matter as the professional discipline of the involved employee resides under nursing practice. There is no need to contact the Clinical Nurse Educator, for that individual would not have access to the employee's personal files.

A group of nurses are discussing safe patient handling and mobility on the nursing unit in relation to nurses sustaining musculoskeletal disorders (MSDs). Which statement made by one of the nurses would indicate that additional training was needed? 1. The most common occurrence for MSDs is when nurses are transferring, lifting, or repositioning patients/clients. 2. It is important to maintain body principles when repositioning a patient/client. 3. If done properly, no nursing action will result in acquiring an MSD. 4. Use of body mechanics while required does not mean that a nurse will not get an MSD.

3. If done properly, no nursing action will result in acquiring an MSD. Research has shown that even if a task/action is done properly, there is still a risk that a nurse could acquire an MSD. The most common occurrences for MSDs arise from nurses performing the tasks of transferring, lifting, and/or repositioning patients/clients. Use of body principles is advised, but even if used does not guarantee that a nurse will not get an MSD.

A nurse has worked for over 20 years in the clinical practice setting and is experiencing considerable back pain at the present time. Questions asked by the health-care provider focus on how the nurse implemented lifting actions during the course of her career. The nurse stated that she "used safe body principles throughout her career." Based on this information, what does the health-care provider suspect might account for the nurse's physical complaints? 1. Undiagnosed scoliosis 2. Improper use of body mechanics 3. Microinjuries to the spine over time 4. Unaware of ergonomic principles as they apply to body mechanics

3. Microinjuries to the spine over time Many health-care workers who utilize manual lifting over time, even if using body principles, are at risk to develop microinjuries to the spine. This effect is cumulative and may not be symptomatic at first. There is no evidence to support scoliosis as no physical assessment data were provided. There is no evidence to suspect improper use of body mechanics or that the nurse is aware of ergonomic principles.

A nurse manager is described by the nursing staff as having a keen insight into the day-to-day operations of the nursing unit. What is the best description of the nurse manager's communication skill? 1. Candid 2. Authentic 3. Mindful 4. Reflective

3. Mindful Candid refers to the ability to be open and honest without bias. Authentic refers to having a sense of purpose and self-awareness. Mindful refers to being aware of both verbal and nonverbal cues in the environment. Reflective refers to thinking about past and present circumstances in order to guide future behaviors.

Which statement is accurate with regard to the concept of competence as applied to nursing practice? 1. Competence is not considered to be an outcome. 2. Competence is a static variable. 3. Nurses must continue to maintain competence following graduation from nursing school. 4. Once competence is assessed, it is achieved and does not need to be re-evaluated.

3. Nurses must continue to maintain competence following graduation from nursing school. Competence must be continued to be attained and maintained upon graduation from nursing school. Competence is also considered to be an outcome. Competence is situational as well as dynamic. Competence must be continually assessed and re-evaluated throughout one's nursing practice.

Which observation if noted on a performance evaluation would require that the supervisor speak with the nurse in order to promote a healthy work environment? 1. Works an overtime shift once every few months 2. Follows policies and procedures 3. Refuses to take breaks while working shifts 4. Takes more time to document using the electronic documentation system compared to other more experienced nurses

3. Refuses to take breaks while working shifts In order to promote a healthy work environment, it is important for nurses to take scheduled breaks so that they can refocus and reflect away from the stress of the workplace environment. The fact that the nurse works overtime infrequently, follows policies and procedures, and takes more time to document as compared to experienced nurses are not factors that would require that the supervisor have a discussion related to promotion of a healthy work environment.

An experienced nurse is applying for a new job position, and an interview has been scheduled. What priority information should the experienced nurse use to help prepare for the upcoming interview? 1. Review of the hospital's website 2. Whether the hospital has achieved Magnet status 3. Review of organization's mission, values, and goals 4. Type of staffing pattern utilized by the facility

3. Review of organization's mission, values, and goals The priority information that an experienced nurse should include to help prepare for a job interview would be to review the organization's mission, values, and goals. This will help to provide a framework of understanding between the prospective employee and the employer. Review of the hospital's website, whether or not the hospital has achieved Magnet status, and type of staffing pattern utilized by the facility would be relevant, but they do not represent priority information.

What component is not included in the SMART technique acronym? 1. Specific 2. Realistic 3. Talented 4. Measureable

3. Talented The SMART technique acronym includes specific, measurable, achievable, realistic, and timely.

Which situation would constitute an example of "bullying" in the nursing environment? 1. The nurse manager instructs a member of the nursing staff in a better way to perform a nursing task. 2. The unit secretary repeatedly talks to nurses and staff in a rude manner. 3. The unlicensed assistive personnel (UAP) on the unit continues to make jokes about another staff member in the presence of others as well as when alone in the staff member's presence. 4. The nurse on the unit gossips about another staff nurse on the unit.

3. The unlicensed assistive personnel (UAP) on the unit continues to make jokes about another staff member in the presence of others as well as when alone in the staff member's presence. This is an example of bullying that includes repetitive attempts to humiliate another individual whether done in a group and/or addressed at the individual level to another person.

Which situation if observed would warrant immediate action by the nurse manager? 1. Staff nurse asks for additional clarification from the physician related to a written order. 2. Unit secretary asks the nurses to answer the unit phone when she is busy. 3. Unit secretary draws caricature images of nursing staff with sarcastic comments. 4. Two nurses who work days are switching their days for the last 2 weeks of the schedule.

3. Unit secretary draws caricature images of nursing staff with sarcastic comments. A caricature with noted sarcastic comments requires that the nurse manager take immediate action in order to prevent an escalation of workplace violence. This action could be construed as bullying by humiliation. The staff nurse asking for clarification of a physician order is an appropriate action and does not require any further action by the nurse manager. The unit secretary asking for assistance with answering phones from nursing staff does not require any further action by the nurse manager. The nurse manager may have to communicate with the two staff nurses who are switching their schedules, but an immediate action is not required.

Which option would reflect best practice when a nurse manager is preparing to do a performance appraisal for an annual review of a staff nurse? 1. Provide anecdotal notes immediately prior to meeting with the staff nurse so that the recollections are easy to retrieve. 2. Arrange to meet with the staff nurse in the middle of his or her scheduled shift. 3. Limit feedback provided so as to expedite the task, as most evaluations tend to make individuals uncomfortable. 4. Discuss plans for professional growth.

4. Discuss plans for professional growth. It is important to discuss professional growth and goals for improvement during a performance appraisal.

What element should not be included in nurse leaders' and managers' responses in handling conflict in the clinical care setting? 1. Assessing needs versus wants 2. Reminding staff that every member should be treated with respect 3. Emphasizing the importance of listening 4. Focusing on "we" rather than "I"

4. Focusing on "we" rather than "I" Nurse leaders and managers must focus on determination of needs rather than wants to deflect conflict. All staff members should be treated with respect in order to facilitate cooperation and understanding. Listening to all involved staff members will help to resolve conflict. Focus should be on "I" rather than "we" in order to avoid adversarial relationships.

The nurse manager has established and implemented a corrective action plan for a staff nurse. The nurse manager has now contacted human resources with regard to this employee to start termination. Which type of violation has occurred based on this information? 1. First 2. Second 3. Third 4. Fourth

4. Fourth For a first violation, the nurse manager would be meeting with the employee to verbally outline an action plan. There would be no meeting with human resources. For a second violation, the nurse manager would be meeting with the employee and establishing a written plan. There would be no meeting with human resources. Human resources can be contacted with a third violation, but it does not result in termination. Evidence to support termination would be indicative of a fourth violation.

Which information is represented by the framed question, "how" of change? 1. Participant stakeholders 2. Rationale 3. Timing 4. Technique

4. Technique This information is represented by the framed question, "how" of change.

You are interviewing a nurse who arrives at the interview using a walker as an assistive device for ambulation. Which question if asked would be construed as violating the American with Disabilities Act of 1990? 1. "Can you perform the duties listed on the job description without accommodation?" 2. "Do you need me to repeat the question?" 3. "Do you think that you can do this job?" 4. "Do you have a disability?"

4. "Do you have a disability?" Asking the individual if he or she has a disability would be viewed as a violation of the ADA Act of 1990. You could ask the individual if he or she could perform the duties listed on the job description. You could also ask the individual if he or she needed a question repeated or if the individual thought that he or she could do the job without being construed as a violation of the ADA Act of 1990.

How many minutes is equivalent to one credit of continuing education credit? 1. 25 2. 60 3. It varies from state to state. 4. 50

4. 50 Fifty minutes is equivalent to one credit of continuing education credit. It does not vary from state to state but represents an established standard.

Which action would help to promote a nurse in becoming a skilled communicator? 1. Limit reflective practices and focus on present interaction. 2. Focus on individual thoughts and beliefs. 3. Believe that all conversations contain credible information. 4. Become more candid.

4. Become more candid. Factors that would contribute to becoming a skilled communicator include becoming aware of self-deception, reflective, authentic, mindful, and candid. It is important to be able to reach out, understand, reflect, and be open to communication. Believing that all conversations contain credible information may lead to inappropriate analysis in that the veracity of all conversations cannot be proven.

A nurse manager attempts to resolve conflict on the unit between staff members by bringing all sides to the table to have a discussion. What type of conflict management strategy is being displayed? 1. Accommodating 2. Competing 3. Avoidance 4. Collaborating

4. Collaborating By bringing all sides to the table to have a discussion, the nurse manager is using collaboration conflict management strategy. This type of strategy promotes a shared approach to resolve conflict. Accommodating conflict management strategy is accomplished by self-sacrifice of needs for the greater good. Competing conflict management strategy is self-directed and competitive in nature and can lead to further aggression. By bringing all sides to the table for a discussion, the nurse manager is not using avoidance conflict management.

An experienced nurse on the medical-surgical unit has a pattern of making rude statements about her co-workers. These repeated statements have become part of the unit culture. How would the nurse manager who has observed these interactions categorize this type of behavior in terms of violence? 1. Hearsay 2. Nurse to patient 3. Vertical 4. Horizontal

4. Horizontal Lateral violence occurs between individuals at the same level. In this situation, the unit culture has been affected by these long-standing patterns. This is not considered hearsay because the information has filtered to all parties and has been observed by various parties. Nurse to patient is when the behavior is directed from the nurse to the patient. In this example, the nurse is only making statements about co-workers. Vertical violence occurs between individuals at different levels, that of a subordinate and another individual at a higher level.

A group of nurses are discussing unit policies and procedures. Based on a consensus of opinion, the nurses suggest minimal changes in the near future. What type of future is demonstrated by this statement? 1. Preferable 2. Plausible 3. Possible 4. Probable

4. Probable A probable future is related to what will occur based on minimal change. The nurses have arrived at a consensus of opinion in their discussion, suggesting minimal change in the near future. A preferable future is related to a vision of what will be and a roadmap design to achieve it. A plausible future is related to what has previously occurred based on current information. A possible future relates to considering all possibilities and leads to seeking the preferable future.

A nurse is reviewing a chart in which a medication error occurred as part of a performance improvement (PI) evaluation. Which notation if observed would indicate a potential contributory factor to the incident based on the concept of nurse fatigue? 1. Clinical response to antibiotic oral medication given by the nurse was not documented. 2. The physician's order was signed off. 3. The pain assessment profile prior to medication being administered was noted as 9 out of 10. 4. The nurse who had administered the medication was working his third shift in a row, which was considered to be an overtime shift.

4. The nurse who had administered the medication was working his third shift in a row, which was considered to be an overtime shift. Research has shown that an increased number of errors is related to increased number of work hours in the clinical setting. Therefore, the fact that the nurse was working an overtime shift would increase the likelihood for an error to occur. Typically, there is no need to indicate a clinical response to oral antibiotic medication unless there is an observed adverse reaction. The physician's order being signed off is an appropriate action. The pain assessment profile being completed is also an appropriate action.

Which action supported by current research contributes to the existence of workplace violence in the clinical setting? 1. Most nurses report incidents that have occurred without fear of retaliation. 2. Nurses are more aware of the likelihood that workplace violence will occur. 3. There are strong organizational support and zero tolerance policies for bullying. 4. There is no support from administration.

4. There is no support from administration. Lack of perceived or actual support from administration can contribute to the occurrence of workplace violence.

There was a violent incident on the medical-surgical unit that occurred between a staff worker and the worker's spouse. How would this be classified according to the National Institute for Occupational Safety and Health (NIOSH)? 1. Type 1 2. Type 2 3. Type 3 4. Type 4

4. Type 4 Type 4, the perpetrator has a relationship with the worker that is personal but has no relationship with the organization. Type 1, the perpetrator has no criminal intent and no relationship with the individual or organization. Type 2, the perpetrator is the customer (consumer) and/or family member who has a relationship with the organization while receiving services. Type 3 refers to the perpetrator being a co-worker and who commits violence on another co-worker.

Which action if used by a nurse manager would lead to increased conflict in the clinical setting? 1. Assessment of needs versus wants 2. Reminding staff that every member should be treated with respect 3. Emphasizing the importance of listening 4. Using statements that focus on the individual performing the behavior indicating "we" or "you"

4. Using statements that focus on the individual performing the behavior indicating "we" or "you" Nurse managers should remain in the "I" position and avoid placing blame by using "we" or "you" as descriptive characteristics. Nurse managers should focus on determination of needs rather than wants in order to decrease conflict. Reminding staff that all members should be treated with respect will help to decrease conflict. Listening to all involved staff members will help to decrease conflict.

In order to promote clinical competencies for the new graduate nurse, which orientation strategy would be most beneficial? 1. Didactic work in a classroom setting with other new hospital staff recruits 2. Taking a computer training class on the hospital's electronic health record system with a designated staff super user 3. Working closely with other new graduate nurses to develop collegiality and professional identity 4. Working with an experienced nurse in a mentor relationship as part of orientation training

4. Working with an experienced nurse in a mentor relationship as part of orientation training Working with an experienced nurse in a mentor relationship as part of orientation training will help to promote clinical competences for the new graduate nurse. It is important to provide an adequate transition to practice (TTP) program so that all nurses can contribute to professional development. Didactic work in a classroom setting with other new hospital staff recruits, although important, will not promote clinical competencies, for there is no application of skills. Taking a computer training class on the hospital's electronic health record system with a designated staff super user is also an important part of training, but it is a single unit experience again with no continued application in the clinical setting. And while it is important to develop a respectful dialog with other new graduate nurses, this will not directly promote clinical competencies.

Mass Trauma or Natural Disasters

Workplace violence can also come in the form of mass trauma, such as biochemical attacks or terrorist attacks, and natural disasters. Nurses' work during mass trauma or natural disasters can be extremely stressful and has the potential to cause serious health and mental health issues

culture of safety

a blame-free environment in which staff members feel comfort- able reporting errors and near misses

workplace violence

a culture of fear, diminish staff morale, impact patient safety and job satisfaction, and drain joy and meaning from work

Change

a dynamic process that results in altering or making something different

performance appraisal

a formal evaluation of the work performance of an em- ployee that is conducted by the nurse leader and manager.

preceptor

a staff nurse who is recognized for his or her clinical competence, leadership abilities, organizational skills, and desire to orient new nurse graduates

360-degree feedback

a type of constructive feed- back in which nurses receive feedback from everyone around them—supervisors, peers, physicians, other health-care professionals, and even patients and their families. Typically, it is anonymous.

workplace safety

a workplace free from risks of both physical and psychological harm

Lateral violence

also known as horizontal violence; consists of bullying or incivility between two or more nurses at the same level

healthy work environment

an environment that is safe, empowering, and satisfying not merely the absence of real and perceived physical or emotional threats to health but a place of physical, mental, and social well-being, sup- porting optimal health and safety

mentor

an experienced individual, who may or may not be a nurse, who is willing to maintain a long-term relationship, empowering, nurturing, advising, and guiding the new nurse graduate throughout his or her professional career

empirical-rational strategy

assumes that staff members are essentially self-interested and providing information and education will assist staff in changing behavior and adopting the change or innovation

power-coercive strategy

based on power and authority and assumes that staff will respond to authority and threats of job loss

vertical violence

consists of bullying or incivility between a nurse subordinate and someone at a higher level

normative-reeducative strategy

focuses on the relationship needs of staff members, uses peer pressure, and relies on staff members' desires to have satisfactory work relation- ships

destructive feedback

includes threats and fear to control employee behavior, by criticizing the employee and making him or her feel humiliated e.g., "Are you stupid? You should never walk out of the patient's room with gloves on!"

Chaos theory

is nonlinear and unpredictable, and it explains why a small change in one area can have a large affect across an organization

Competence

is situational and dynamic and requires performing at an expected level that integrates knowledge, skills, attitudes, and nursing judgment

peer review

nurses from common practice areas assess, monitor, and make judgments about the quality of nursing care provided by a nurse peer

change agent

one who leads and manages the change process, including management of group dynamics, resistance to change, continuous communication, and the momentum toward the desired outcome

lifelong learner

one who seeks continuing education opportunities to increase his or her knowledge and skills and improve his or herattitudes throughout his or her professional and personal life

plausible future

or what could be, focuses on what may occur based on current and projected trends

Nurse-to-Nurse Violence

physical or nonphysical violence between or among nurses who have a workplace relationship, has many other names, such as lateral violence, horizontal violence, and vertical violence

Planned change

purposeful, calculated, and collaborative, and it includes the deliberate application of change theories

disparity

racial or ethnic differences in the quality of healthcare that are not due to access-related factors or clinical needs, preferences, and appropriateness of intervention

reflective learning

represents recurrent thoughtful personal self-assessment, analysis, and synthesis of strengths and opportunities for improvement

Constructive feedback

supportive, motivates the employee to succeed and grow, and involves showing respect and praising the employee for a job well done e.g., "I really appreciate how you handled that difficult patient yesterday")

Coaching

the art of guiding another individual toward fulfilling his or her future; to assist a person in achieving his or her goals, a coach helps him or her develop and prioritize viable solutions and then act on them

cultural competence

the attitude, knowledge, and skills necessary for providing quality care to diverse populations

diversity

the range of human variations, including age, race, gender disability, ethnicity, nationality, religious and spiritual beliefs, sexual orientation, political beliefs, economic status, native language and geographical background

External Violence

violence is perpetrated by outside persons entering the workplace or when nurses are going to or from the workplace. This type of violence is type 1 according to NIOSH. It is usually random, and the perpetrators typically have criminal intent, such as rape, assault, armed robbery for drugs, or gang reprisals in emergency departments

possible future,

what may be, considers all possible situations that could occur

preferable future

what should be and begins with a vision and a roadmap to get there

probable future

what will likely occur and actually reflects the present state with minimal changes

Organizational Violence

affects the entire health-care organization and occurs as a result of a changing work environment

What elements are included in the hallmarks of a professional nursing practice environment? 1. Minimal staffing patterns 2. Nursing staff members who have limited input 3. A formal program for performance improvement 4. Limited accountability but with increased responsibility

3. A formal program for performance improvement Hallmarks of professional nursing practice environment include a formal program to evaluate performance improvement. They also include adequate staffing patterns, nursing staff members having input to processes, and accountability with responsibility.

Incivility

disrespect, rudeness, and general disdain for others

Sexual Harassment

has not received as much attention in recent nursing literature as workplace violence, yet it is still prevalent. Inappropriately friendly behavior, sexually based verbal comments, vulgar, sexual language or inappropriate jokes or stories; unwelcome advances or requests for sexual favors; unwanted physical contact of a sexual nature; and sexual innuendo

Patient-to-Nurse Violence

involves a patient or family member being violent toward a nurse and falls under the NIOSH type 2 category. A patient hitting or biting a nurse is an example of this type of violence. A family member yelling at a nurse is another example.

disruptive behavior

non-verbal behavior, eye rolling, on one end of the spectrum and physical violence and tragedy on the other

Nurse-to-patient violence

occurs when nurses are violent toward those in their professional care, with a resulting violation of the nurses' code of ethics. The most blatant example of this type of violence is a nurse hitting a patient.